Pick’s disease with Pick bodies combined with progressive supranuclear palsy without tuft‐shaped astrocytes: A clinical,neuroradiologic and pathological study of an autopsied case

We report clinical, neuroradiologic features, and neuropathologic findings of a 76‐year‐old man with coexistent Pick’s disease and progressive supranuclear palsy. The patient presented with loss of recent memory, abnormal behavior and change in personality at the age of 60. The symptoms were progressive. Three years later, repetitive or compulsive behavior became prominent. About 9 years after onset, he had difficulty moving and became bed‐ridden because of a fracture of his left leg. His condition gradually deteriorated and he developed mutism and became vegetative. The patient died from pneumonia 16 years after the onset of symptoms. Serial MRI scans showed progressive cortex atrophy, especially in the bilateral frontal and temporal lobes. Macroscopic inspection showed severe atrophy of the whole brain, including cerebrum, brainstem and cerebellum. Microscopic observations showed extensive superficial spongiosis and severe neuronal loss with gliosis in the second and third cortical layers in the frontal, temporal and parietal cortex. There were Pick cells and argyrophilic Pick bodies, which were tau‐ and ubiquitin‐positive in neurons of layers II–III of the above‐mentioned cortex. Numerous argyrophilic Pick bodies were observed in the hippocampus, especially in the dentate fascia. In addition, moderate to severe loss of neurons was found with gliosis and a lot of Gallyas/tau‐positive globus neurofibrillary tangles in the caudate nucleus, globus pallidus, thalamus, substantia nigra, locus coeruleus and dentate nucleus. Numerous thorned‐astrocytes and coiled bodies but no‐tuft shaped astrocytes were noted in the basal ganglion, brainstem and cerebellar white matter. In conclusion, these histopathological features were compatible with classical Pick’s disease and coexistence with progressive supranuclear palsy without tuft‐shaped astrocytes.     

MRV检测脑静脉窦血栓的作用

目的探讨磁共振静脉血管成像(MRV)用于检测脑静脉窦血栓(CVT)的应用价值。方法8例CVT患者均行MRI标准自旋回波T1WI、T2WI和VEN/3D/PCA。结果VEN/3D/PCA比标准SE序列T1WI和T2WI多检测出CVT3处,与脑血管造影的结果完全相符。结论MRV可以准确无创的诊断CVT。     

肾上腺素对氯普鲁卡因硬膜外阻滞患者药效学和药代动力学的影响

目的观察1:20万肾上腺素对3％盐酸氯普鲁卡因硬膜外阻滞患者药效学和药代动力学的影响。方法择期行下腹部手术患者20例,ASAⅠ或Ⅱ级,随机分为2组(n=10):盐酸氯普鲁卡因组(C组)和盐酸氯普鲁卡因加肾上腺素组(CE组)。分别用3％氯普鲁卡因6 mg·kg-1(C组)和含 1:20万肾上腺素3％氯普鲁卡因6 mg·kg-1(CE组)硬膜外阻滞,记录局麻药的起效时间、运动阻滞起效时间和给药后20min时运动阻滞程度;分别在给药前及给药后3、6、9、11、13、15、17、20、30、45、60、 90min采取桡动脉血1．5ml,高效液相色谱法检测血浆氯普鲁卡因浓度,经计算机软件拟合血药浓度 -时间曲线,并计算各项药代动力学参数。结果两组局麻药的起效时间、运动阻滞起效时间和运动阻滞程度差异无统计学意义。C、CE组血药浓度峰值(Cmax)分别为0．49±0．47、(0．32±0．22)mg· L-1,达峰值时间(Tmax)分别为8±3、(9±4)min;血药浓度曲线下面积(AUC)分别为10±6、(7±4)μg· min·ml-1;清除速率常数(K)分别为0．32±0．21、(0．36±0．32)min-1;两组间Cmax、Tmax、AUC及K比较差异无统计学意义(P>0．05)。结论 1:20万肾上腺素对3％盐酸氯普鲁卡因硬膜外阻滞的药代动力学和药效学没有影响。     

内镜辅助方型脸改型术

目的探讨内镜在方型脸改型术中的临床应用效果。方法采用口内入路，在内镜辅助下，用高速涡轮气钻截除肥大下颌角、切除部分咬肌和颊脂垫，进行方型脸的面部改型。结果本组共38例，其中男3例，女35例，年龄21～40岁。内镜完全可以清楚显示下颌升支、下颌角、下颌体下缘，视野清晰。使用高速涡轮气钻截除肥大下颌角可以更加精确和容易，且创伤小，出血少，手术时间短，感染风险低。下面部轮廓改善满意。结论内镜辅助方型脸改型术，有助于获得良好的手术效果。     

充气温控毯用于神经外科手术患者的控温效果

目的评价充气温控毯用于神经外科手术患者的控温效果。方法40例择期行平卧位脑肿瘤切除术患者,年龄16—65岁,体重41-72 kg,ASAⅠ-Ⅲ级,随机分为2组(n=20):A组,术中充气温控毯24℃风档进行降温,肿瘤切除完毕前30 min进行复温;B组,术中充气温控毯维持中心温度正常(35．2—36．60℃)。均采用气管内静吸复合麻醉,静脉注射异丙酚1．5～2 mg／kg、芬太尼4-6μg／kg、维库溴铵0．1～0．2 mg／kg诱导,吸入0．6％-1．2％异氟醚维持;吸入氧浓度40％;异丙酚1．5～2 mg·kg-1·h-1持续输注;维库溴铵1～2 mg间断静脉注射。每5分钟记录1次中心温度(鼻咽温),观察围术期不良反应及并发症。结果A组2例患者因手术时间超过24 h剔除,共38例进行统计。A组患者降温速率(1．11±0．05)℃／h,复温速率(0．74±0．09)℃／h。A组患者89％(16/18)在硬脑膜打开前达到目标温度34℃,平台期平均中心温度(34．3±0．5)℃,距34℃最大升幅0．52℃,最大降幅为0．23℃。A组患者67％(12／18)手术结束时中心温度恢复正常。返回ICU后A组患者中心温度(返回ICU时实测温度的均值)(35．8±0．6)℃低于B组(36．6±0．4)℃(P<0．05)。A组患者4例术后出现寒颤、3例发热、1例死亡。结论神经外科手术中应用充气温控毯可较理想地降低体温,相对于降温效率其复温效率偏低。     

后十字韧带重建后移植物组织学与胶原表型的变化

目的探讨采用半腱肌腱重建后十字韧带（posterior cruciate ligament,PCL）后移植物的组织学与胶原表型的变化.方法取20只成年新西兰大白兔,实验组18只切除右膝PCL后即刻用双股自体半腱肌腱重建,实验组于术后3、6、52周各处死动物2只,12、26周各处死动物6只,切取半腱肌腱移植物;对照组2只直接切取半腱肌腱和PCL.标本采用HE、甲苯胺蓝以及Ⅰ、Ⅲ型胶原免疫组化染色观察移植物的组织学与胶原表型变化,并与正常半腱肌腱和PCL进行比较.结果常规组织化学染色显示正常半腱肌腱和PCL在细胞构成上有明显的差别,PCL内可见软骨样细胞;重建后的移植物经过坏死、细胞重新长入、胶原形成和重塑阶段,52周时形成的结构类似于正常PCL,但在纤维排列上与正常PCL仍有差异.免疫组织化学染色结果显示正常PCL纤维内部仅有Ⅰ型胶原表达,重建韧带Ⅰ型胶原染色随时间延长从少到多,Ⅲ型胶原染色从多到少,52周时移植物内局部仍有表达.结论采用半腱肌腱重建PCL 52周时移植物和正常PCL结构相似,但仍有差异.     

剖宫产术后硬膜外血肿并发脊髓损伤病人的护理

我科于2004年1月救治1例因羊水栓塞引起硬膜外血肿导致脊髓损伤的病人,针对病人存在或潜在的功能障碍和并发症采取了有效的干预。随着现代医学的发展,更多的脊髓损伤(spinal cordinjury,SCI)病人可存活下来,但绝大部分人留有重度残疾,生活质量受到严重影响[1]。因此,对SCI病人康复期存在或潜在的功能障碍和并发症采取干预性护理措施,可预防和减少脊髓功能的进一步损害,尽可能在较短时间内使病人达到生活自理,对其重返社会具有重要意义[2]。1病例介绍病人,32岁,孕40周,2004年1月10日因妊娠高血压综合征收住入院。11日03:40因胎儿宫内窘迫…     

血色病肝脏铁过度沉着症1例

1.病例资料：患者，男，48岁。以“乏力、多饮、多尿、多食，伴消瘦4个月，加重1周”入院。既往有乙型肝炎和地中海贫血病史30年，无输血史，无血色病家族史，曾行“脾脏切除”治疗。查体：慢性贫血面容，全身皮肤黄染有散在色素沉着，巩膜黄染，双手肝掌，男性乳房发育；肼右肋下3cm，剑突下5cm，质硬；腹部未触及肿块。     

扶正固本法对青少年哮喘患者基因表达的影响

目的 研究复方中药敏康片治疗青少年哮喘的疗效和作用机理。方法 选择20例青少年哮喘患者进行治疗，另设青少年特应性皮炎患者组（20例）和青少年正常组（19例）为对照。哮喘组和皮炎组口服敏康片，疗程为6个月，观察疗效、血清总IgE及FcεRIβ、IL-4Rα基因表达改变情况。结果 哮喘组显效6例，有效12例，无效2例，总有效率90％；皮炎组显效4例，有效13例，无效3例，总有效率85％；哮喘组IgE治疗前后有显著差异（P〈0．01）。皮炎组IgE治疗前后有差异（P〈0．05）；用Northern blot法检测FctRlt3、IL-4Rα基因，IL-4Rα吸光度值两组治疗前均较正常组高，哮喘组治疗后降低。FcεRIβ吸光度值两组治疗前均较正常组高，治疗后均降低。结论 复方中药可以调整青少年哮喘患者相关基因表达，改善患者过敏状态，缓解临床症状。     

大鼠异体肢体移植术后急性排斥反应阶段血管内皮细胞ICAM-1表达的动态变化

Objective To investigate the dynamic changes of intercellular adhesion molecule-1 (ICAM-1) expression in endothelial cells (EC) during hindlimb allograft acute rejection in rats and the inhibitory effect of cyclospofine A (CsA) on the acute rejection. Methods The rat model of hindlimb allograft was developed. The rats were randomly divided into following groups: control group (Wistar→Wistar), rejection group ( Sprague-Dawley→Wistar) and CsA-treated group (Sprague-Dawley→Wistar). At postoperative day 1, day 4 and day 7samples of the femoral artery from the allograft limb were harvested to observe the pathologic changes. ICAM-1 expression in EC was quantified using immunohistochemical assay. Results Slight swelling and weak ICAM-1expression of EC were observed in the control group. In the rejection groups, obvious EC swelling and massive lymphocyte infiltration were seen. ICAM-1 expression in EC was significantly stronger and elevated. In CsA-group only mild infiltration of lymphocytes was seen and ICAM-I expression in EC was also much weaker.Conclusion During rat hindlimb allograft acute rejection the expression of ICAM-1 in EC was closely related to the occurrence and development of acute rejection. CsA could reduce the expression of ICAM-1 in EC and hence inhibit acute rejection of composite allograft.